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A.

Bulimia nervosa may not be that easy to spot from a distance, but the body definitely knows that something is wrong. Besides nutritional problems, the violence of binging and purging food can literally tear holes in internal organs. Even in the absence of these dramatic events, bulimia puts the body through consistent and debilitating internal trauma.

Bulimia and Medical Problems in the Digestive System

Bulimia taxes the digestive system heavily, asking it to perform tasks for which it is not intended:

• Binging can push the stomach to its limits, causing ruptures.
• Frequent vomiting takes its toll as well. Vomiting ultimately can lead to inflammation of the esophagus and, in extreme cases, ruptures.
• Many with bulimia choose to purge by using laxatives rather than vomiting. But laxative abuse trains the digestive tract to be unable to process food without the laxatives. The result can be chronic irregular bowel movements and constipation.
• The frequent passing of stomach acid through the esophagus by purging seems to be connected with a condition called Barrett's esophagus, in which the lining of the esophagus becomes like the lining of an intestine. In rare cases, people with Barrett's esophagus develop esophageal adenocarcinoma, a type of cancer that is often deadly.
• Repeated purging causes the stomach lining to weaken. Acids can then burn the stomach wall, which can create ulcers. When an ulcer makes a hole in the stomach (or any other organ), it is called a perforating ulcer. A perforating ulcer can be life-threatening if not treated.

Purging From Bulimia Dehydrates the Body

The body loses fluids when purging occurs. Dehydration can lead to low blood pressure or to orthostatic hypotension, a sudden drop in blood pressure that occurs when you sit or stand up. Severe, untreated dehydration can produce seizures, damage the brain permanently, or cause death.

Bulimia's Dangerous Electrolyte Problems

In addition to dehydration, purging eliminates electrolytes like potassium and sodium from the body. Because electrolytes help the nervous system transmit messages throughout the body, low levels of electrolytes are serious health problems. Electrolyte imbalances can lead to irregular heartbeats (arrhythmias) and even heart failure and death.

Stomach Acid From Purging Harms the Teeth

Stomach acid is hydrochloric acid. The stomach's lining is especially suited to provide a buffer for this acid. Other surfaces, like tooth enamel, are vulnerable to staining, decalcification, and severe erosion from stomach acid.

It isn't always easy to see tooth decay in a person with bulimia before it becomes severe. Since the acid approaches the teeth from the throat, erosion begins on the back of the teeth. A dentist can verify whether damage is present or not.

Purging in Bulimia Can Lead to Anemia

Purging removes iron from the body. When the body develops an iron deficiency, anemia results. Anemia makes it hard for blood to bring oxygen to the various parts of the body, which can lead to fatigue and shortness of breath. Anemia can also increase the chance of infections and heart palpitations.

Other Medical Problems Associated With Bulimia

• Swelling of salivary glands from self-induced vomiting
• Amenorrhea: When bulimia leads to low body weight, missed menstrual cycles are common.
• Bloating and water retention
• Chronic sore throat

Sources:

MedlinePlus. Dehydration. Accessed 22 August 2007.

National Digestive Diseases Information Clearinghouse. Barrett's esophagus. Accessed 22 August 2007.

National Eating Disorders Association. Health consequences of eating disorders. Accessed 18 August 2007.

Seidenfeld, Marjorie E. K. and Rickert, Vaughn I. Impact of anorexia, bulimia and obesity on the gynecologic health of adolescents. American Family Physician 64 (2001): 445-450.

University of Michigan Health System. Penetration and perforation of ulcers. Accessed 27 August 2007.